血液腫瘤病患人工血管照護品質改善專案

Hematology-Oncology Port-A: Improving Nursing Care Quality

背景：血液腫瘤病患裝置人工血管以利化學治療，卻易血流感染影響預後。護理因其獨特地位得成為醫療團隊領導角色，藉由高品質護理、執行需要的改變，以預防人工血管血流感染並改善病人照護成效。2008年7月至2009年6月，本單位發生12件人工血管血流感染案例，感染率3.18‰。經現況分析發現主要原因為：(1)護理人員人工血管照護知能不足；(2)人工血管護理技術標準及敷料更改；(3)病患及家屬人工血管自我照護不足。因而成立專案小組進行改善。目的：本專案旨在提昇護理人員執行人工血管照護品質，以降低病患血流感染率。解決方案：於2009年8月15日至2009年12月20日執行改善策略，包含：(1)修訂人工血管護理技術標準；(2)更換敷料型號；(3)執行不定期技術稽核；(4)舉辦人工血管護理教育訓練；(5)統一病患及家屬對人工血管的自我照護指導標準。結果：血液腫瘤病患人工血管血流感染率由3.18‰降至0.99‰，下降率68.87%。結論：本專案有效降低人工血管血流感染率、提升病患安全及臨床照護品質，可作為同儕單位照護血液腫瘤病患之參酌。

Background: Hospitalized hematology-oncology patients undergoing chemotherapy face a significant risk of port-A related bloodstream infections. Nurses are uniquely positioned to help adjust clinical practices necessary to prevent port-A related bloodstream infections and improve patient outcomes. Between July 1st, 2008 and June 30th, 2009, twelve patients in our ward were stricken with port-A related bloodstream infections (an infection rate of 3.18‰). Data analysis indicated inadequate nursing competency in all aspects of port-A care. Nurses did not have adequate knowledge of port-A modified standard care protocols and did not provide dressings suited to hematology-oncology patient needs. Also, both patients and caregivers lacked adequate skin care knowledge. Our team developed a project to address and minimize port-A related bloodstream infection issues in our hospital.Objects: The authors designed this project to enhance integration of both the central line insertion care and maintenance practice bundles in order to reduce port-A related bloodstream infection incidence.Resolution: The plan was implemented from August 15, 2009 to December 20, 2009. It included establishing a standardization port-A care protocol, implementing a more appropriate dressing type, performing an irregular audit of port-A care techniques, holding educational training, and establishing skin care instructions for patients and their families.Results: Hematology-oncology patient port-A related bloodstream infections fell from 3.18‰ pre-implementation to 0.99‰ post-implementation. The effective rate of improvement was 68.87%.Conclusion: Standardization of Port-A care under this project achieved infection reduction results that achieved our anticipated goals. This project furthermore enhanced the delivery and quality of patient nursing services. This experience can serve as a reference to medical organizations involved in hematology-oncology patient care.